Guest post: Fainting and fits in children – would you know the difference?

My son has fainted this morning, for the first time in his life. Although I remember in minute detail each one of the four faints I have had in my life, I was not prepared for what happened this morning.

My six-year old was sitting on my lap in the bathroom while we were chatting about his wobbly front tooth and the possibility of it falling out before his seventh birthday. He rose to get up to reach for his toothbrush, and all of a sudden he arched his back and started falling backwards. If not for his glassy, quite lifeless wide-open eyes directed at me, I would have thought he was messing, that in an instant he’d start giggling and say something like, “Did my zombie face scare you?” Instead, he was falling head down on the tiled floor, and luckily I caught him in time. He is a tall and lanky boy, so I held to his long limp body for dear life while I screamed for help from my husband.

Every one of the faints I’ve had myself started with some swooshing sounds in my ears, then the head got dizzy, my vision became blurred, and gradually everything turned black. Whoooosh… I was out. But from the first swooshing sounds and an everything-around-you-is-swirling sensation to total darkness there can pass from 2 to 4-5 minutes. In children, this process is fast.

When my son came around he looked absolutely normal and aware of what had happened to him. When I asked him how he had felt back then on my lap in the bathroom, he couldn’t remember any dizziness or unpleasant sensations. The lack of the typical fainting precursors in him frightened me and remembering that faints and fits can look alike I called my paediatrician friend to set my mind at peace.

Fainting

Fainting (in medical terms ‘syncope’) is a sudden loss of consciousness due to a reduced blood flow (and therefore oxygen) to the brain. It is most likely caused by the change in physical conditions of the person losing consciousness. A fit or a seizure happens due to a neurological cause. One of the main signs that distinguishes fainting from neurological fits is that a fainting spell normally lasts no longer than 1 or 2 minutes. If your child does not regain consciousness within that time, you need to call an ambulance.

Here are the most common causes of fainting in children:
• Overheating or being in hot and overcrowded environment
• Dehydration
• Hunger leading to low blood sugar level
• Sharp or severe pain
• Having to stand still for a long period
• Stress and intense emotions
More serious causes of fainting can include:
• Underlying cardiac rhythm problems
• Congenital heart disease
• Anaemia

Seizures, fits or convulsions

A seizure or fit is a sudden disturbance of the nervous system function caused by an abnormal nerve discharge in the brain. During a fit (seizure or convulsion) the child will have a sudden episode of abnormal movements of the limbs, stiffening of the body or disturbed consciousness.

Paediatricians say that during infancy and early childhood a recurrent fit usually reflects underlying structural brain lesions or one of several specific seizure syndromes.

Although the manifestations of a non-neurological fainting are quite different from those of seizures or convulsions, there are two types of fits that fall somewhere in between due to their symptoms. They are ‘absence’ and breath-holding attack.

Absence

Historically called a ‘petit mal’, this type of fit is caused by abnormal and intense electrical activity in the brain, which lasts between 10 and 30 seconds.

The child, who is typically aged between 5 and 15, abruptly stops what they were doing and ‘stares into space’. This episode can happen when the child is talking, walking and even eating, where his hand is hung in mid-air and the food never reaches his mouth. Absence spells may happen infrequently or several times per hour. At school children who experience absence are often wrongly labelled daydreamers or lacking focus. One of the giveaway signs that you child may have had an absence spell is their lack of memory about it and the feeling of tiredness which follows.

The vast majority of children will outgrow absence spells, and only a quarter will develop another, more serious, type of seizure. Hence if your kid has had a number of absence spells it’s best to investigate them with a paediatrician.

Breath-holding attack

A breath-holding spell is a common and generally harmless occurrence affecting mostly young children, between the age of 1 and 3. These spells would have begun following a minor injury or frustration. In a typical scenario of the attack the child will take breath to cry, may or may not cry out and then will hold his breath when breathing out.

What follows afterwards can look very traumatic to the people around. The child tries to breathe in, but is unable to do it because of the spasm of the muscles of the upper throat. He may become blue or deep red colour, his arms may appear stiff, and the neck and back would be rigid. The heart slows down and as a result the child loses consciousness. The episode of breath-holding attack can last only a few seconds, after which the child relaxes and begins to breathe normally.

Paediatricians say that breath-holding attacks follow a pattern. If your toddler has had it once, expect them to continue for some time.

My 3-year old niece had breath-holding spells a few times a week, and after the first few times when her parents realised that they were not life-threatening episodes, she was nicknamed ‘beetroot face’ due to the colour she developed during an attack. It is a widely held misconception that children hold their breath purposefully in inspiration, however, research indicates that there is no voluntary aspect to breath-holding spells.

Things to do to help your child recover after a non-neurological loss of consciousness.
• Let your child lay down on a flat surface.
• Wait until your child comes around naturally (unless you have smelling salts in the house).
• Once he/ she comes around give them a glass of water
• If there are no medical contraindications, give them something sweet to eat, preferably a few squares of milk chocolate, a spoonful of honey or a toast with jam. A quick sugary snack will give them a boost of energy following their fainting.
• Once your kid gets on his feet (literally), try to ask him gently about how he felt before and after the fainting spell.

Remember, in most cases, fainting is harmless (apart from any physical injury your child may have endured in the fall). However, fits or absence spells might be a sign of something serious going on. Sometimes young kids may feel frightened after a spell of fainting or fit, hence try to discuss the issue with your GP discreetly in their presence.

Katya Bobova is a freelance journalist who specialises in writing about child development issues. In her areas of research she tries to answer one question: Why do child experts change their opinions so often? She has written about toddler and baby nutrition, practices of co-sleeping in different cultures, sibling relations etc. and is a regular contributor to Baby London magazine.